MNsure client aid organizations feeling squeezed

MNsure Executive Director April Todd-Malmlov answers questions during a news conference about the marketplace's plans and rates Friday, Sept. 6, 2013 at the State Capitol in St. Paul. The agency is still vetting grant applications and putting the final touches on training -- two things that shouldn't be rushed, Todd-Malmlov said.
MPR Photo/Jennifer Simonson

MNsure wants Ruby Lee's organization to spread the word to Latino communities about the state's new health insurance marketplace. But MNsure, she says, is not making it easy.

With MNsure's opening less than two weeks away, Lee's contract with MNsure wasn't finalized until Monday. She won't tap any of the nearly $100,000 contract funding until MNsure approves her overall spending plan. Lee said delays at MNsure have prevented her from hiring anyone to assist consumers with enrollment, and she has no idea when she can start training those people once she does hire them.

The compressed timeline, she said, is "disrespectful" to organizations like hers, Comunidades Latinas Unidas En Servicio, that will do much of the work helping more than 1 million Minnesotans get health insurance through the exchange.

"If you don't provide the tools necessary to succeed -- well, then, you're setting them up for failure," said Lee, the group's president. "To do it the right way, you should allow for enough time for training, enough time for us to hire staff."

Lee's is among the groups chosen to receive part of $4 million in federal grants to help enroll people in MNsure. Some are feeling similar a similar squeeze. Over the past week, MPR News contacted all 30 groups getting grants and reached executives at 15. At the time MPR News spoke with them, most said they hadn't yet signed a contract with MNsure; all said they were awaiting training on how the new MNsure website will operate.

Responses to the situation vary. Some organizations urge calm; some are adjusting their schedules and moving plans later into the fall. Others worry the late start could slow or impede enrollment in MNsure if a lack of assistance discourages consumers who want to sign up.

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For months, MNsure has touted the network of consumer assisters that will help get uninsured Minnesotans find plans. But the agency is still vetting grant applications and putting the final touches on training -- two things that shouldn't be rushed, MNsure executive director April Todd-Malmlov said.

"Training is very important to us, outreach is extremely important to us, which is why we want to make sure we are providing the most up-to-date information and training" Todd-Malmlov said. "We are taking our due diligence with everyone that is going to be working on the ground with the public."


Some groups have delayed events designed to encourage enrollment because they won't have staff trained to use MNsure soon enough.

Other organizations slated to receive the grants say there's nothing to fret about.

"We wish that everyone would calm down a little," said Arnie Anderson, executive director of the Minnesota Community Action Partnership. "Most of America runs on business processes that are just in time. There's every reason to believe that MNsure's just-in-time implementation will work out just fine as well."


Getting CLUES staff trained is Lee's top priority. If her employees aren't ready by Oct. 1, she said it could prevent people who need insurance from getting it.

"The negative impact is that the people who are underserved continue to be underserved," she said. "They continue to be part of the inequities that systems create. We are about breaking barriers, and not creating more barriers for them to participate in systems that are available to them."

Todd-Malmlov said that the web-based training will be available early next week, and she estimates it will typically require 15 hours to complete, plus the time to pass a competency test, Todd-Malmlov said.

Nevertheless, Liz Olson is preparing for delays. Her group, Generations Health Initiative in Duluth, is at the heart of a 16-organization network in northeastern Minnesota that will help educate and enroll residents in MNsure health plans.

Initially, her coalition planned to canvas residents door-to-door and then host a major event in early October where people could get help enrolling in MNsure. The event has now been moved to mid-November.

"A few months ago, I think we were under the assumption that we would be able to start just ready to hit the ground running ... materials in hand Oct. 1," Olson said. "Seeing that things are taking a little bit longer, we're shifting how we're going to approach it to more of an education and outreach focus to start, knowing that we will hit enrollment hard later."

In southwestern Minnesota, Western Community Action Development Director Allan Bakke said delays could mean added stress for his clients, many of whom are already struggling financially. Under the Affordable Care Act most people who are without insurance will be subject to a financial penalty starting next year.

"If people are already having difficulty meeting basic needs, and there is this mandate that they have to have insurance... and if we're not able to help them secure that, they're just going to be put under more pressure," he said. "I think that we're doing them a disservice."


Some grantees said they've had difficulty getting information from MNsure, which has been under a time crunch from the start.

Olson with Generations Health Initiative said she knows MNsure employees have tackled a mountain of work.

"Yet at the same time we're going to be the folks that are going to help to make them successful, so investing some time and energy into us is going to pay off ten-fold," Olson said.

While groups like Olson's may not be completely ready on day one, Todd-Malmlov pointed out that Oct. 1 is just the start of enrollment. Coverage doesn't go into effect until Jan. 1, and even then, people have until March of next year to find a plan.

"There is going to be plenty of time for people to evaluate their options and get covered," she said.

Big projects like this often experience setbacks at the start, but eventually things fall into place, said Cathy Rucci, executive director of MORE in St. Paul, which is getting a grant.

"There's a lot that needs to happen in the next couple of weeks," she said. "I'm not sure if it's going to be able to happen that quickly. And I'm OK with that. We will just follow (MNsure's) lead."